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Synthetic scaffolds, as an alternative to allograft and xenograft scaffolds, are suitable for bone regeneration. This study aimed to synthesize a composite biomaterial of zeolite and beta-tricalcium phosphate (βTCP) to obtain a biocompatible material with physical and mechanical properties in bone regeneration. One scaffold without zeolite (βZG 0) and two scaffolds with different amounts of zeolite (βZG 1 and βZG 2) were synthesized. The scaffolds were evaluated by FTIR, XRD, compressive strength test, MTT assay, and radiographic and histological analyses. The XRD results confirmed the presence of βTCP and ZSM-5 phases in the composite scaffolds and also, indicated that the addition of gelatin decrease the crystallinity of composite scaffolds. FTIR revealed the gelatin, β-TCP and ZSM-5 functional groups in the composite structure. βZG 2 group had the maximum porosity among the scaffolds (74%) ranging in size from 61-600 µm. Compressive strength test showed that the Young’s modulus changed from 23 MPa to 59 MPa, and the zeolite nanostructure was the most influential factor responsible for this change. The MTT assay showed the superiority of βZG 2, and the macroscopic and microscopic results at 4, 8, and 12 weeks revealed the maximum bone regeneration and formation of bone trabeculae in the βZG 2 and βZG 1 groups, respectively. The zeolite scaffold showed the superior mechanical, radiographic and histological properties compared with the control and non-zeolite scaffold. βTCP/ Zeolite/ Gelatin scaffold can be an appropriate candidate for medical application in bone regeneration.

Introduction Ossifying fibroma (OF) is a rare type of tumor characterized by fibrous tissue proliferation with cementum- or bone-like hard tissue formation. Since its first report by Montgomery in 1927, several cases of OF have been reported; however, no cases of OF arising from the zygomatic arch have been reported. Herein, we report a case of OF arising from the zygomatic arch. Clinical case summary A 70-year-old female visited our department in February 2017 because of a gradually growing osseous protrusion in the right zygomatic region, which she was aware of since the previous 6 months. A 3.3 cm × 3.2-cm area of swelling was observed in the region. Computed tomography confirmed the presence of a granulated lesion on the surface of the right zygomatic arch. Accordingly, benign bone tumor was diagnosed, and tumor resection was subsequently performed. Histopathological analysis revealed irregularly arranged bone trabeculae, an increased number of fibroblasts, and collagen fibers between the bone trabeculae; accordingly, OF was diagnosed. No clinical or radiographic evidence of recurrence was observed during the 1.5-year follow-up period. Discussion A granulated lesion was present on the surface of the right zygomatic arch, and the boundary between the lesion and surrounding bone was clear. Resection of the lesion from the zygomatic arch was relatively easy. Thus, OF was diagnosed. If OF is suspected, a risk of recurrence persists; therefore, shaving the area including the bones surrounding the lesion may be necessary. Although detailed causes of OF and osteoma remain unknown, past trauma has been indicated as a common etiology. However, compared with the frequency of fractures in the zygomatic arch, the frequency of OF and osteoma is rare; thus, the etiology of OF and osteoma remains to be fully elucidated.

Pulpal/periapical responses of human teeth that are treated successfully with tricalcium silicate-based materials are extremely difficult to obtain because of the typical unavailability of these teeth for histologic examination. The present case series reports histologic and histobacteriologic findings of 3 human teeth that had undergone pulpotomy, orthograde retreatment, and apicoectomy/root-end filling using tricalcium silicate-based endodontic materials. The teeth were extracted after 34 days, 7 weeks, and 20 months, respectively, because of unusual circumstances. The extracted teeth were processed, paraffin embedded, sectioned, stained with hematoxylin-eosin or the modified Brown and Brenn technique, and examined with light microscopy. The recurrent observation for the 3 cases presented was the absence of inflammatory or foreign body reactions of the host tissues in contact with tricalcium silicate-based materials after different observation periods despite the identification of bacteria in dentinal tubules close to the site of operation. Wound healing was rapid with repair/regeneration of lost tissues with cementum and new bone trabeculae. Although the level of evidence for a case series is low because of the anecdotal nature of the reported episodes, the histologic results reported in the present case series illustrate the highly biocompatible and bioactive nature of the tricalcium silicate-based materials used in treating these cases.

We carried out a differential diagnosis of a large frontoparietal lesion on a human skull from a Late Bronze Age archaeological site located on the Central Plain of China, dating to between 771 and 476 BC. The head of this individual was covered in cinnabar, a mercury-based pigment that later was used for medicinal purposes in China. The lesion was well-circumscribed and involved the outer and inner tables of the skull, slight diploë thickening, and coarsening of bone trabeculae with expansion of intertrabecular spaces. We show that the observed changes are most consistent with cavernous hemangioma of the skull, a benign vascular malformation that preferentially affects older adults. Hemangiomas are often neglected in the paleopathological literature because of their benign nature - they tend to be asymptomatic and do not affect quality of life to a significant degree. Nevertheless, they produce characteristic lesions that can be confused with several other conditions with unrelated etiologies, including congenital hemoglabinopathies, traumas, malignant or benign neoplasms, and Paget's disease. We outline the diagnostic criteria that distinguish cavernous hemangioma from other conditions affecting the skull.

Cemento-osseous dysplasia is a benign lesion which affects the jaw bones. It is a frequent incidental finding but no aggressive therapy is necessary. However, it may be confused with more aggressive entities, such as ossifying and cementifying fibroma, which do require treatment. There are no clear-cut histopathological criteria to differentiate between these entities. We present a case of a 13-year old boy who underwent a biopsy of a clinically undiagnosed maxillary lesion. Histopathological analysis revealed moderately cellular fibrous tissue with bone trabeculae with no osteoblastic rimming and clusters of intensely basophilic material corresponding to cementum. The final diagnosis was cemento-osseus dysplasia. The main histopathological features important in the distinction of these entities are discussed.

Cleidocranial dysplasia (CCD) is an autosomal dominant disorder caused by heterozygous mutations in RUNX2. Affected individuals exhibit delayed maturation or hypoplasia in various bones, mainly including those formed by intramembranous ossification. Although several reports described deformation of the sphenoid bone in CCD patients, details of the associated changes have not been well documented. Most parts of the sphenoid bone are formed by endochondral ossification; however, the medial pterygoid process is formed by intramembranous ossification associated with secondary cartilage. We first investigated histological changes in the medial pterygoid process during different developmental stages in Runx2+/+ and Runx2+/- mice, finding that mesenchymal cell condensation of the anlage of this structure was delayed in Runx2+/- mice as compared with that in Runx2+/+ mice. Additionally, in Runx2+/+ mice, Osterix-positive osteoblastic cells appeared at the upper region of the anlage of the medial pterygoid process, and bone trabeculae appeared to associate with subsequent secondary cartilage formation. By contrast, few Osterix-positive osteoblastic cells appeared at the upper region of the anlage of the medial pterygoid process, and no bone trabeculae appeared thereafter in Runx2+/- mice. At more advanced embryonic stages, endochondral ossification occurred at the lower part of the medial pterygoid process in both Runx2+/+ and Runx2+/- mice. After birth, well-developed bone trabeculae occupied two-thirds of the cranial side of the medial pterygoid process, and cartilage appeared beneath these bones in Runx2+/+ mice, whereas thin trabecular bone appeared at the center of the cartilage of the medial pterygoid process in Runx2+/- mice. In adult mice, the body and medial pterygoid processes of the sphenoid bone comprised mature bones in both Runx2+/+ and Runx2+/- mice, although the axial length of the medial pterygoid processes was apparently lower in Runx2+/-mice as compared with that in Runx2+/+mice based on histological and micro-computed tomography (CT) examinations. Moreover, medical-CT examination revealed that in CCD patients, the medial pterygoid process of sphenoid bone was significantly shorter relative to that in healthy young adults. These results demonstrated that the medial pterygoid process of the sphenoid bone specifically exhibited hypoplasia in CCD.

Background and objective: Computational homology is an emerging mathematical tool for characterizing shapes of data. In this work, we present a methodology using computational homology for obtaining quantitative measurements of the connectivity in bone morphometry. We introduce the Betti number ratios as novel morphological descriptor for the classification of bone fine structures in three dimensions. Methods A total of 51 Japanese white rabbits were used to investigate the connectivity of bone trabeculae after the administration of alendronate in a tendon graft model in rabbits. They were divided into a control group C and an experimental group A. Knee joints specimens were harvested for examination of their bone trabecular structure by micro-CT. Applying the computational homology software to the reconstructed 3D image data, we extract the morphological feature of a steric bone structure as the Betti numbers set (β0, β1, β2). The zeroth Betti number β0 indicates the number of the connected components corresponding to isolated bone fragments. The first and second Betti numbers, β1 and β2, indicate the numbers of open pores and closed pores of bone trabeculae, corresponding to a 2D empty space enclosed by a 1D curve and a 3D empty space enclosed by a 2D surface, respectively. Results We define the Betti number ratios β1/β0 and β2/β0 to better distinguish the two groups A and C in the scatter plots. Testing the discriminant function line for 29 data points of A (22 data points of C), the 17 points (resp. 18 points) are correctly classified into group A (resp. C). The accuracy rate is 35/51. The classification results in terms of the Betti number ratios are consistent with the histomorphometric measurements observed by medical doctors. Conclusions: This study is the first application of computational homology to bone morphometry in three dimensions. We show the mathematical basis of the Betti numbers index which are useful in a statistical description of the topological features of sponge-like structures. The potential benefits associated with our method include both improved quantification and reproducibility for the stereology.

Three-dimensional (3D) matrices scaffolds play a noteworthy role in promoting cell generation and propagation. In this study, scaffolds prepared from chitosan/polyvinyl alcohol loaded with/without an osteoporotic drug (risedronate) and nano-bioactive glass (nBG) have been developed to promote healing of bone defects. The scaffolds were characterized by scanning electron microscopy (SEM), porosity test as well as mechanical strength. The pattern of drug release and ability to promote the proliferation of Saos-2osteosarcoma cells had also been reported. Osteogenic potential of the scaffolds was evaluated by testing their effect on healing critical-sized dog's mandibular bone defects. Increasing chitosan and nBG in the porous scaffolds induced decrease in drug release, increased the scaffold's strength and supported their cell proliferation, alkaline phosphatase (ALP) activities, as well as increased calcium deposition. Histological and histomorphometric results demonstrated newly formed bone trabeculae inside critical-sized mandibular defects when treated with scaffolds. Trabecular thickness, bone volume/tissue volume and the percentage of mature collagen fibers increased in groups treated with scaffolds loaded with 10% nBG and risedronate or loaded with 30% nBG with/without risedronate compared with those treated with non-loaded scaffolds and empty control groups. These findings confirmed the potential osteogenic activity of chitosan/polyvinyl alcohol-based scaffolds loaded with risedronate and nBG.

Purpose To compare the effectiveness of two forms of phytoestrogens in Soybeans as a graft material in bony defects. Material and methods Eighteen bone defects were created in the parietal bones of nine New Zealand white rabbits. Three groups were divided (Six defects each) and filled with either material A in group I, or material B in group II, or left empty as control group. One gm of the purified active fraction obtained from seeds of Glycine max L. (Soybean) Family Leguminosae, rich in isoflavones (Material A) was tested as well as a prepared semi solid pharmaceutical paste (Material B) of the crude bioactive fraction. Defects and surrounding tissue were decalcified and routinely processed for Haematoxylin and Eosin staining. The area percent of newly formed bone was estimated using an image analyzer computer system. Comparison of the results of all groups were carried out.co ANOVA test was used for statistical analysis. Results Regularly arranged, osteoid newly formed bone almost filled the surgical defect in group1, while group 2 revealed partial obliteration of the bony defect with dispersed irregularly arranged bone trabeculae, separated by fibrovascular marrow. Scarce bone trabeculae and wide fibrovascular marrow spaces were observed in the control group. This difference was statistically significant (P Conclusion The results of this study suggest that phytoestrogens obtained from Soybeans seeds in form of semi solid pharmaceutical paste is more effective than the crude bioactive fraction of the same plant. Further comparative studies are needed on extended time intervals.

The idiopathic bone cavity (IBC) is an intraosseous pseudocyst devoid of epithelial lining. Clinically, IBCs of the jaw are asymptomatic and normally found in routine radiographic exams. Although the literature regarding the content of IBCs is controversial, the final diagnosis is usually aided by the discovery of an empty cavity upon surgical exploration. The aim of this study was to perform cytological and histological analysis of IBC contents. Cytological analysis of nine cases of IBC was performed after puncture and processed by the cell block technique. Histological analysis was performed in six cases in which it was possible to collect enough material by curettage of bone walls. Remarkably, cell block analysis revealed the presence of fibrin, often arranged as a net; erythrocytes; and inflammatory cells, with a predominance of lymphocytes as well as some macrophages and neutrophils. Histological analysis showed the presence of scant connective tissue, bone trabeculae, hemorrhagic foci, and hemosiderin. Only two cases presented scattered multinucleated giant cells. Cytological evaluation of IBC content by the cell block technique might represent a useful diagnostic tool, especially in cases in which there is no available material for curettage in the cavity.

Bone tissue is a biological system in which the dynamic processes of, among others, bone formation or internal reconstruction will determine the spatial structure of the tissue and its mechanical properties. The appearance of a factor disturbing the balance between biological processes, e.g. a disease, will cause changes in the spatial structure of bones, thus affecting its mechanical properties. One of the bone diseases most common in an increasingly ageing population is osteoarthritis, also referred to as degenerative joint disease. It is estimated that in 2050 about 1300 million people will show symptoms of OA. The appearance of a pathological stimulus disturbs the balance of the processes of degradation and synthesis of articular cartilage, chondrocytes and the extracellular matrix, and the subchondral bone layer. As osteoarthritis progresses, study of the epiphysis reveals increasingly widespread changes of the articular surface and the internal structure of bone tissue. In this paper, the authors point out the differences in the mechanical properties of cancellous bone tissue forming the proximal epiphysis of the femoral bone during the progressive stages of OA. In order to determine microproperties of bone trabeculae, specimens from different stages of the disease (N=9) were subjected to microindentation testing, which made it possible to determine the material properties of bone tissue, such as microhardness HV and Young׳s modulus E. In addition, mechanical tests were supplemented with Raman spectroscopy, which determine the degree of bone mineralization, and measurements of structural properties based on analysis using microCT. The conducted tests were used to establish both quantitative and quantitative description of changes in the structural and mechanical properties connected with reorganization of trabeculae making up the bone in the various stages of osteoarthritis. The proposed description will supplement existing knowledge in the literature about identification of the processes occurring during the development of this disease.

Background Like osteonecrosis of the femoral head (ONFH), subchondral insufficiency fracture of the femoral head (SIF) causes femoral head collapse. However, little is known about the differences between the two diseases regarding the morphological features of the collapsed lesion. We tested the hypothesis that the morphological features of the lateral collapsed lesion would differ between ONFH and SIF. Methods Twenty femoral heads histopathologically diagnosed as ONFH (n=10) or SIF (n=10) were used in this study. In the lateral collapsed lesion of each femoral head, cubic regions of interest (ROIs) were selected within the collapsed subchondral area and the nearby non-collapsed subchondral area. Micro-CT–based microarchitectural parameters were compared between the ROIs in each disease. Additionally, correlations between histopathological and microarchitectural features were evaluated. Results In ONFH, bone volume fraction, trabecular thickness, and bone mineral density in the collapsed area were all significantly lower than those in the nearby non-collapsed area where thickened bone trabeculae accompanied by appositional bone formation were invariably seen. On the other hand, in SIF there were no significant differences between the ROIs in any of these microarchitectural parameters. Histopathologically, varying degrees of callus formation overlying the fracture of the subchondral plate were seen around the lateral collapsed lesion. Conclusion The morphological features of the lateral collapsed lesion were inconsistent between ONFH and SIF, suggesting different pathomechanisms of femoral head collapse.

Degradable bone substitutes like Mg-based alloys are promising due to their good osseointegration and biocompatibility. The objective of this study was to investigate the influence of additional coatings on the degradation behavior, osseointegration and gas release of 128 open porous scaffolds (O 4 mm, length 5 mm) of the magnesium alloy LAE442 (4 wt% Li, 4 wt% Al, 2 wt% rare earths). Along a base layer of MgF2 polylactide acid (PLA) or calcium phosphate (CaP) were applied. While the resorbable PLA was supposed to delay the magnesium degradation, the CaP should form a nutrient depot for growing bone. The control group consisted of 32 β-tricalcium phosphate (TCP) scaffolds. The scaffolds were inserted into the greater trochanter of 80 adult female ZiKa rabbits. X-ray and in vivo μCT scans were performed postoperatively at regular intervals of 6, 12, 24, 36 weeks. Gas accumulation, scaffold degradation and osseointegration were evaluated. In comparison, PLA-coated scaffolds degraded slightly slower, but had a significantly greater amount of gas in the medullary canal at weeks 2 and 4 compared to CaP-coated scaffolds. CaP-coated scaffolds showed better values for drill hole closure and a significantly higher number of bone-scaffold contacts from week 12 to 36 compared to PLA. Furthermore, CaP-coated scaffolds showed higher bone volume and more new formed bone trabeculae than PLA-coated scaffolds. In total, an additional coating with CaP seemed to be promising in improving the degradation resistance and osseointegration, when using biodegradable bone substitutes.

In histology textbooks, the vertebrate skeleton is represented as almost entirely made of bone and cartilage. This is a false dichotomy and in fact, a continuum of intermediate tissues between bone and cartilage exists. Chondroid bone ([CB] or chondroid tissue), one of the most well-known intermediate tissues, has been reported in mammals, birds and crocodilians. It accommodates (1) rapid growth of the skull and (2) the development of craniofacial sutures. Since CB is present in the extant phylogenetic bracket of the Dinosauria, we hypothesized that it was also present in non-avian dinosaurs. By means of paleohistological examination and microradiography, we report for the first time the presence of CB in non-avian dinosaur embryos and nestlings (Ornithischia: Hadrosauridae). It was found in five locations: (1) scattered within the bone trabeculae of an embryonic surangular; (2) and (3) in the coronoid process and in the alveolar processes of an embryonic dentary; (4) in the mandibular symphyses of an embryonic and a post-hatching dentary; (5) at the fronto-postorbital suture of an embryo. In these areas, CB was present in large amounts, suggesting that it played an important role in the rapid growth of the hadrosaurian skull during embryonic development. Moreover, the CB present in the sutural borders of a Hypacrosaurus frontal suggests that it was also involved in sutural growth, as it has been reported to be in mammalian and avian sutures. This is the first step taken to document and understand dinosaurian sutures from a histological perspective and it sheds light on an old problem by reporting the presence of CB in an additional clade within the Vertebrata. It is parsimonious to propose that CB in the chick embryo, Gallus gallus, the American alligator, Alligator mississippiensis and the hadrosaurs of the present study are homologous and that CB arose once and was inherited from their common ancestor [Présence de tissu chondroïde chez des embryons et des jeunes de dinosaures (Ornithischia : Hadrosauridae) : implications sur la croissance du crâne et l’évolution des tissus squelettiques] Selon les précis d’histologie, le squelette des vertébrés est formé exclusivement d’os et decartilage. Ceci est une dichotomie erronée, car il existe en fait un continuum de tissus inter-médiaires entre l’os et le cartilage. Le tissu chondroïde (TC, ou os chondroïde) fait partie destissus intermédiaires les plus connus et a été rapporté chez les mammifères, les oiseauxet les crocodiliens. Il autorise (1) la croissance rapide du crâne et (2) le développementdes sutures cranio-faciales. Puisque le TC est présent dans le clade d’inférence justifiée(extant phylogenetic bracket) de Dinosauria, nous avons émis l’hypothèse qu’il était égale-ment présent chez les dinosaures non aviens. Grâce à une analyse paléohistologique etmicroradiographique, nous documentons pour la première fois la présence de TC chez desembryons et de jeunes dinosaures non aviens (Ornithischia : Hadrosauridae). Ce tissu a étéobservé dans cinq localisations : (1) au milieu de travées osseuses d’un surangulaire embry-onnaire ; (2) et (3) dans les processus coronoïde et alvéolaires d’un dentaire embryonnaire ;(4) au niveau des symphyses mandibulaires d’un embryon et d’un jeune hadrosaure ; (5)au niveau de la suture fronto-postorbitaire d’un embryon. Dans ces cinq sites, le TC étaitprésent en grande quantité, ce qui suggère un rôle important dans la croissance rapide ducrâne des hadrosaures durant leur développement embryonnaire. De plus, la présence deTC dans les aires suturales du frontal d’Hypacrosaurus suggère que ce tissu jouait aussi unrôle dans la croissance suturale, comme déjà rapporté chez les mammifères et les oiseaux.Ceci est un premier pas pour documenter et mieux comprendre les sutures des dinosauresd’un point de vue histologique. Cette étude rapporte la présence de TC dans un clade addi-tionnel de vertébrés. Il est parcimonieux de proposer que le TC présent chez les embryonsde poulet, Gallus gallus, chez les embryons d’alligators américains, Alligator mississippiensis,et chez ces embryons d’hadrosaures est homologue et qu’il leur aurait été transmis par leurancêtre commun.

Purpose To assess the distributions of stress, strain, and fractured areas using a finite element model (FEM), and examine the osteoclastic activity histopathologically in osteonecrosis of the femoral head. Methods Three femoral heads were obtained during hip arthroplasty for femoral head osteonecrosis. One sample with a normal area, two samples with a non-sclerotic boundary without collapse (Type 1), two samples with a non-collapsed sclerotic boundary (Type 2), and two samples with a collapsed sclerotic boundary (Type 3) were collected from each femoral head for the FEM and histopathological analyses. FEM was performed using CT data, and the distributions of von Mises equivalent stress, octahedral shear stress, octahedral shear strain, and simulated fractured area were evaluated. Furthermore, the osteoclast count at the boundary was compared for each type. Results In normal and Type 1 samples, the distributions of von Mises equivalent stress, octahedral shear stress, octahedral shear strain, and the fractured area were equally concentrated along the whole analytical range; however, in the Type 2 and 3 samples, they were concentrated along the thickened bone trabeculae at the boundary, which corresponded to the fractured area. Histopathologically, a significantly increased osteoclast number was observed only at the collapsed sclerotic boundary. Conclusion These results demonstrated that both shear stress and shear strain tend to be concentrated on thickened bone trabeculae at the boundary. Fracture analyses revealed that the boundary of sclerotic changes, which results from the repair process, may be the starting point of the fracture. Additionally, the osteoclastic activity increases after collapse.

Odontogenic myxoma (OM) is a benign neoplasm often affecting mandibular molars. Although small tumors may be asymptomatic, bigger lesions may result in bone swelling, and aggressive cases show fast growth. Radiographies show unilocular lesions, multilocular lesions, and bone trabeculae arranged at right angles, with irregular margins and dental displacement/resorption. Sometimes soap bubbles appearance is present. A 50-year-old male patient was referred for examination of an asymptomatic radiographic finding in the right mandible. Cone beam computed tomography showed an irregular hypodense area, with poorly defined margins, in the right mandibular body extending to the anterior region, with small cortical expansion. After incisional biopsy, the histopathologic analysis showed proliferation of spindled- and stellate-shaped cells in an abundant loose and myxoid stroma. The diagnosis of OM was given. Subsequent hemimandibulectomy was performed for total tumor excision. The patient remains in follow-up.

Juvenile ossifying fibroma is a benign fibro-osseous neoplasm of mesenchymal origin that affects young individuals and has an aggressive clinical behavior with high rates of recurrence. A 5-year-old female patient presented intraosseous growth, approximately 1.5 cm in size, normochromic, hard in consistency, sessile, with painful symptoms and 1-month of evolution. Imaging examination revealed well-delimited hypodense lesion and buccal and lingual cortical expansion. The patient had already performed an incisional biopsy with ossifying fibroma diagnosis. Then, an excisional biopsy was accomplished in association with local bone curettage. Microscopic examination showed fusiform and oval mesenchymal cell proliferation. There was deposition of numerous bone trabeculae with varying degrees of maturation, exhibiting prominent osteoblastic paving. After 1 year, the patient is still on regular follow-up, with no signs of recurrence.

Pseudocarcinomatous hyperplasia (PCH) consists of a non-neoplastic epithelial hyperplasia that can mimic squamous cell carcinoma (SCC) both clinically and histopathologically. Some inciting factors have been associated with PCH, including trauma, infection, chronic inflammation, and neoplasia. A 57-year-old female patient, heavy smoker, was referred with complaint of pain at level of the tooth #16, where there was an implant. Clinical examination revealed discharge of pus and swelling of the peri-implant mucosa. Radiographic examination showed progressive bone loss around the dental implant. Therefore, the implant was removed, and the surrounding soft tissue was sent for histopathologic analysis, which revealed foci of the hyperplastic epithelium in the connective tissue that projected from the surface epithelium, surrounding isolated bone trabeculae, and admixed with chronic inflammation. In this case, a relationship between peri-implantitis and PCH is probable, which should be included within the histopathologic spectrum of this peri-implant disease, to avoid misdiagnosis with SCC.

Craniofacial fibrous dysplasia (CFD) is a benign bone development anomaly characterized by involvement of the skull and facial bones. This disease can affect 1 bone or multiple bones resulting in deformity, fractures, and pain. An 18-year-old male with facial asymmetry presented with an extensive and not well-demarcated lesion involving the left craniofacial side. Tomographic examination showed an expansive bone lesion with loss of corticomedullary differentiation affecting the left maxilla, maxillary sinus, ethmoid, sphenoid infundibulum, and nasal and frontal bones. After biopsy, the microscopic examination revealed irregular trabeculae of the lamellar bone immersed in a moderately cellularized and vascularized dense connective tissue. Curvilinear bone trabeculae arranged in a pattern of Chinese letter form was noted. The diagnosis of CFD was made. The treatment has consisted of multiple surgeries to restore the facial contour and asymmetry. The patient remains in follow-up.

The purpose of this study was to evaluate alterations and bone tissue response on laser treated implant surfaces (Nd:YAG – 100 W). Sixty grade II titanium (ASTM F67) mini-implants (1.5 mm × 4.0 mm) were installed in femurs of 30 Wistar rats. The animals were divided into two groups: thirty mini-implants were machined elements (Machined Group) and the other thirty had laser beamed surfaces (Laser Group). The animals were subdivided into three groups, according to bone healing periods of 15, 30 and 60 days. The samples were analyzed under light, scanning electron and confocal 3D microscopy as well as by EDS (energy dispersive spectroscopy) and Student's t test was used for statistical analyses. Light microscopy results showed new bone trabeculae formation toward laser-treated implants at 15 days’ bone repair as well as thin layers of osteoid matrix, indicating high biocompatibility. Similar features were observed in the Machined Group but only after 30 days. Bone/implant contact was better evidenced on laser-treated surfaces compared to that on simply machined implants. The only group that demonstrated change in level of significance was the laser-treated group at the 15-day-healing period (p

Many studies have assessed the effects of either low-level laser therapy (LLLT) or low-intensity pulsed ultrasound (LIPUS) on bone repair; however, an evaluation of the combination of these modalities (LLLT + LIPUS) has not yet been considered. The aim of this study was to demonstrate the effects of LLLT + LIPUS on bone repair. Male Wistar rats (n = 128; four groups of 32) were used; the animals underwent a partial tibial bone osteotomy. One group had the osteotomized limb treated with LLLT, the second group with LIPUS, and the third group with the combined treatment protocols of the LLLT and LIPUS groups; the fourth group received no further treatment (control). Each group was divided into two subgroups for assessment at two different time-points, 14 and 21 days. After the completion of treatment rats were sacrificed and the tibias submitted to a three-point bending test or to histomorphometric analysis. Histological evaluation showed increased bone trabeculae, increased vascularization, and decreased inflammation in the LLLT + LIPUS group. Mechanical evaluation revealed increased biomechanical properties including maximum force, maximum stress, and stiffness, in the LLLT + LIPUS group. Combined LLLT + LIPUS treatment enhanced bone healing both histologically and mechanically, shortening the length of the treatment period, when compared to treatment with LLLT or LIPUS alone.

Bone growth on and into implants exhibiting substantial surface porosity is a promising strategy in order to improve the long-term stable fixation of bone implants. However, the reliability in clinical applications remains a point of discussion. Most attention has been dedicated to the role of macroporosity, leading to the general consensus of a minimal pore size of 50–100 μm in order to allow bone ingrowth. In this in vivo study, we assessed the feasibility of early bone ingrowth into a predominantly microporous Ti coating with an average thickness of 150 μm and the hypothesis of improving the bone response through surface modification of the porous coating. Implants were placed in the cortical bone of rabbit tibiae for periods of 2 and 4 weeks and evaluated histologically and histomorphometrically using light microscopy and scanning electron microscopy. Bone with osteocytes encased in the mineralized matrix was found throughout the porous Ti coating up to the coating/substrate interface, highlighting that osseointegration of microporosities (

Background Gubernaculum dentis (GD) is an anatomic structure, described in the literature as an eruption pathway from the dental follicle to the gingiva for permanent teeth.1 This is the first reported case of a GD associated with a transmigrating canine.2 Clinical and Radiologic Findings A 60-year-old female of Indian origin presented for evaluation for implant placement to replace a clinically missing lower canine tooth. Her medical history was unremarkable. Cone beam computed tomography (CBCT) of the mandible was performed, and the image demonstrated the presence of a corticated tract of low density, contiguous with the dental follicle of the horizontally displaced and impacted mandibular left canine. The tract extended from the pericoronal space around the impacted tooth toward the alveolar crest. The structure measured 2 cm long and 2 mm wide. Differential or Definitive Interpretation On the basis of the clinical and radiographic findings, this structure was diagnosed as GD and had to be differentiated from bone trabeculae, medullary spaces, neurovascular bundles, or sinus tracts. Because this is considered a normal anatomic structure, no biopsy was indicated.1 Discussion Histologically, GD consists of a fibrous band running in the bony channel that connects the pericoronal follicular tissue of the successional tooth with the overlying gingiva. Typically, GD opens on the alveolar bone crest behind the deciduous teeth. Radiographically, GD appears as a corticated tract of low density, contiguous with the dental follicle of an unerupted tooth on CBCT.3 It would be difficult to visualize the very thin and round radiolucent structures with a diameter of only 1 to 3 mm on 2-dimensional radiographs. In addition, the structure lies in the spongy bone of the maxilla and the mandible. Therefore, GD has not received adequate attention in dental fields, including oral and maxillofacial radiology.

Introduction During root formation, Smad-4 plays a key role during the epithelial–mesenchymal interactions and the Hertwig's epithelial root sheath (HERS) apical proliferation. The root formation and eruption of rat molars is impeded by alendronate treatment due to the inhibition of bone resortion by this drug. The present study aimed to examine the structures affected in the developing root and immunodetect the presence of Smad-4 in rats treated with alendronate. Methods Newborn Wistar rats were daily injected 2.5 mg/kg alendronate (ALN) during 9, 12 and 30 days. The controls (CON) were injected with saline. The maxillae were fixed and embedded in paraffin or Spurr resin. Paraffin sections were incubated in Smad-4 antibody that was labelled with DAB. The ultrathin sections were examined in a transmission electron microscope. Results In ALN, a short portion of root dentine was formed; the epithelial diaphragm (ED) and the dental follicle (DF) were disorganized by the contact of bone trabeculae. The (CON) molar roots developed normally. Smad-4 labelling was detected in the cytoplasm of fibroblasts and cementoblasts adjacent to the cementum in CON; in ALN group, few ED cells presented weak immunolabelling. Ultrastructurally, the ED and DF appeared disrupted due to the presence of thin bone trabeculae between its cells. It resulted in the lack of apical proliferation of HERS and, consequently, arrest of root formation. Conclusion The immunodetection of Smad-4 in the DF cells of ALN specimens indicates that the signalling for the differentiation of these cells into cementum-forming fibroblasts and cementoblasts occurs, despite the impairment of root elongation.

Herein, we present a rare case of intraosseous leiomyosarcoma arising in the epiphysis of the distal femur and showing unusual radiographic features. A 44-year-old man presented with a pain in the left knee joint. Computed tomography revealed an intraosseous lesion with slightly increased attenuation and a thin marginal sclerotic rim in the femoral medial condyle. The signal of the lesion was hypointense on T1-weighted magnetic resonance (MR) images and hyperintense on fat-suppressed T2-weighted MR images. After gadolinium administration, the signal of the lesion was moderately and diffusely enhanced. The histological diagnosis of leiomyosarcoma was made based on a preoperative core biopsy specimen. Microscopic examination of the resected specimen revealed an ill-defined intraosseous tumor composed of proliferated atypical and mildly pleomorphic smooth muscle cells permeating among the bone trabeculae with only focal destruction of the bone trabeculae and low mitotic activity, indicating low grade leiomyosarcoma. The bone trabeculae at the periphery of the tumor were mildly thickened and anastomosed with a rim of an increased number of osteoblasts. Systemic examination showed no tumorous lesions in other anatomical sites. Leiomyosarcomas rarely present in the bone as a diffuse intertrabecular growth, even in low grade tumors.

Objective In this work we evaluated the bone-forming potential of BMP4, TGFβ1 and BMP4/TGFβ1 mixed by performing histological and morphometric analysis. We also evaluated the immunolabelling of fibronectin (FN) and collagen type III (Col III), two determinant proteins for the early phase of bone repair. Design Histological, histomorphometric and immunohistochemistry analysis were used to evaluate new bone and blood vessels formation as well as fibronectin and collagen type III expression. 112 male Wistar rats weighing 250–300 g had their maxillary second molar extracted. Sockets filled with blood clot (BC) or treated with L (empty liposome), P (PBS), BP (BMP-4 in PBS) and TP (TGF-β1 in PBS), as well as with BL (BMP-4 in liposome) and TL (TGF-β1 in liposome) administered isolated or in association (BTL) were obtained. The animals were sacrificed at 3, 7, 14 and 21 days after surgery. Results An increased percentage of bone trabeculae, and a higher number of blood vessels were observed in groups BL or TL administered isolated or in association when compared to groups BC, L, P, BP and TP. Fibronectin and collagen type III analysis revealed enhanced expression firstly detected at 3 days followed by a peak at 7 days. Lower levels of immunoreactivity were observed in the sockets filled with blood clot, and treated with L, P, BP and TP when compared with sockets from groups BL, TL and BTL. Conclusion The present study indicates growth factors carried by liposomes, either in isolated or associated forms, as successful enhancers of the healing process in rat tooth sockets. We also conclude that the expression of fibronectin and collagen type III increases during the early phases of bone repair.

Purpose To investigate the effect of low-intensity ultrasound on mandibular osteoradionecrosis. Materials and Methods Using a canine model, radiotherapy was delivered to the mandible at doses of 25 and 28 Gy. The microstructure of the mandible and changes in microvascular density in the low-intensity ultrasound treatment (group A) and nontreatment (group B) groups were determined and compared with those of the control group. Results At a single dose of 28 Gy, the canines developed epilation of the mandibular skin, ulcers, and small pieces of oral sequestered material. The microvascular density in group A was significantly greater than that in group B (P < .05). Most osteocytes in group B had disappeared, with atrophy of the cancellous bone trabeculae. In contrast, in group A, a substantial amount of bone had been formed, with increasing amounts of bone trabeculae and a large number of osteoblasts. Conclusions Low-intensity ultrasound effectively improves the healing of irradiated bone.

Ameloblastoma with bone formation is rare. We report a case of a 55-year-old woman with ameloblastoma accompanied by prominent osteoplasia. Histopathological examination exhibited an abundant stromal component between tumor nests. Therefore, she was diagnosed as the desmoplastic variant, except for the numerous bone trabeculae. The distinction between new bone formation and invasion of the bone marrow poses a problem. A thin rim of fibrous bone that can be accentuated by Masson-trichrome staining suggests the former.

For a better understanding of traumatic bone fractures, knowledge of the mechanical behavior of bone at high strain rates is required. Importantly, it needs to be clarified how quasistatic mechanical testing experiments relate to real bone fracture. This merits investigating the mechanical behavior of bone with an increase in strain rate. Various studies examined how cortical and trabecular bone behave at varying strain rates, but no one has yet looked at this question using individual trabeculae. In this study, three-point bending tests were carried out on bovine single trabeculae excised from a proximal femur to test the trabecular material's strain rate sensitivity. An experimental setup was designed, capable of measuring local strains at the surface of such small specimens, using digital image correlation. Microdamage was detected using the bone whitening effect. Samples were tested through two orders of magnitude, at strain rates varying between 0.01 and 3.39 s(-1). No linear relationship was observed between the strain rate and the Young's modulus (1.13-16.46 GPa), the amount of microdamage, the maximum tensile strain at failure (14.22-61.65%) and at microdamage initiation (1.95-12.29%). The results obtained in this study conflict with previous studies reporting various trends for macroscopic cortical and trabecular bone samples with an increase in strain rate. This discrepancy might be explained by the bone type, the small sample geometry, the limited range of strain rates tested here, the type of loading and the method of microdamage detection. Based on the results of this study, the strain rate can be ignored when modeling trabecular bone.

β-Tricalcium phosphate (β-TCP) is a suitable biomaterial in oral and maxillofacial surgery since it can induce a rapid proliferation of woven bone. Granules, prepared by the polyurethane foam method, were implanted in critical size defects performed in the femoral condyles of New Zealand rabbits. Animals were studied after 8 and 28 days. Ketoprofen (a non-steroidal anti-inflammatory drug (NSAID)) was given for 8 and 28 days to evaluate its effects on the healing of the graft. Before euthanasia, the rabbits received an intravenous injection of fluorescent microbeads. Bones were analyzed by microcomputed tomography. β-TCP granules induced metaplastic bone trabeculae as early as 8 days post-surgery. At 28 days, the amount of bone was increased and the biomaterial volume decreased due to simultaneous macrophagic resorption. The amount of macrophages labeled with microbeads was less in the grafted area than in the vicinal intact marrow spaces. Ketoprofen had no effect on the amount of bone formed and on the number of labeled macrophages. The influence of small doses of NSAID, given in a short duration period, did not present deleterious effects on bone graft healing.

Scanning acoustic microscopy (SAM) provides high-resolution mapping of acoustic impedance related to tissue stiffness. This study investigates changes in tissue acoustic impedance resulting from mechanical loading in trabecular bone cores cultured in 3-D bioreactor. Trabecular bone cores were extracted from bovine sternum (n = 15) and ulna metaphysis (n = 15). From each bone, the samples were divided in three groups. The basal control (BC) group was fixed post-extraction, the control (C) and loaded (L) groups were maintained as viable in a controlled culture-loading cell over three weeks. Samples of L group underwent a dynamic compressive strain, whereas C samples were left free from loading. After three weeks, L and C samples were embedded in polymethylmethacrylate and all samples were explored with a 200-MHz SAM. For each specimen, the acoustic impedance distribution was obtained over flat and polished section of bone blocks prepared parallel to the loading axis. Our results showed that in basal controls, the acoustic impedance varied with bone anatomical location and was 15% higher in weight-bearing ulna compared with nonweight-bearing sternum. The comparison between loaded and nonloaded groups showed that sternum-only exhibited significant change in acoustic impedance (L vs. C sternum: +9%). This result suggests that when the applied load is comparable with the stress naturally experienced by a weight-bearing bone (ulna), the tissue material properties (manifested by acoustic impedance) remained unchanged. In conclusion, SAM is a potentially relevant tool for the assessment of subtle changes in intrinsic microelastic properties of bone induced by adaptive remodeling process in response to mechanical loading.

This study investigated the relationships between trabecular microstructure and elastic modulus, compressive strength, and suture anchor pullout strength. Twelve fresh-frozen humeri underwent mechanical testing followed by micro-computed tomography (microCT). Either compression testing of cylindrical bone samples or pullout testing using an Arthrex 5mm Corkscrew was performed in synthetic sawbone or at specific locations in the humerus such as the greater tuberosity, lesser tuberosity, and humeral head. Synthetic sawbone underwent identical mechanical testing and microCT analysis. Bone volume fraction (BVF), structural model index (SMI), trabecular thickness (TbTh), trabecular spacing (TbSp), trabecular number (TbN), and connectivity density were compared against modulus, compressive strength, and pullout strength in both materials. In cadaveric bone, modulus showed correlations to all of the microstructural properties, while compressive and pullout strength were only correlated to BVF, SMI, and TbSp. The microstructure of synthetic bone differed from cadaveric bone as SMI and TbTh showed little variation across the densities tested. Therefore, SMI and TbTh were the only microstructural properties that did not show correlations to the mechanical properties tested in synthetic bone. This study helps identify key microstructure-property relationships in cadaveric and synthetic bone as well as illustrate the similarities and differences between cadaveric and synthetic bone as biomechanical test materials.

Mechanical testing has been regarded as the gold standard to investigate the effects of pathologies on the structure-function properties of the skeleton. With recent advances in computing power of personal computers, virtual alternatives to mechanical testing are gaining acceptance and use. We have previously introduced such a technique called structural rigidity analysis to assess mechanical strength of skeletal tissue with defects. The application of this technique is predicated upon the use of relationships defining the strength of bone as a function of its density for a given loading mode. We are to apply this technique in rat models to assess their compressive skeletal response subjected to a host of biological and pharmaceutical stimulations. Therefore, the aim of this study is to derive a relationship expressing axial compressive mechanical properties of rat cortical and cancellous bone as a function of equivalent bone mineral density, bone volume fraction or apparent density over a range of normal and pathologic bones. We used bones from normal, ovariectomized and partially nephrectomized animals. All specimens underwent micro-computed tomographic imaging to assess bone morphometric and densitometric indices and uniaxial compression to failure. We obtained univariate relationships describing 71-78% of the mechanical properties of rat cortical and cancellous bone based on equivalent mineral density, bone volume fraction or apparent density over a wide range of density and common skeletal pathologies. The relationships reported in this study can be used in the structural rigidity analysis introduced by the authors to provide a non-invasive method to assess the compressive strength of bones affected by pathology and/or treatment options.

A thorough understanding of age-related phenomena on the trabecular architecture in the human lumbar spine can help the diagnosis and prognosis of age-related architectural changes, and provide an insight into the corresponding clinical assessments. In this paper we considered the different loading conditions of the young and old lumbar spines mainly caused by disc degeneration and studied the effect of loading alteration on trabecular architecture in lumbar spines. A two-dimensional μFE models with a 40 μm pixel resolution were built to represent the full trabecular architecture in the human lumbar spine, and a topology optimization with the aid of finite element method was conducted to numerically investigate the trabecular morphological changes. Topology optimization iteratively distributes material in a design domain producing optimal layout or configuration, and it has been widely and successfully used for the study of bone remodeling. As a result of adaptive response of bone remodeling due to different loading conditions, we obtained two distinctively different trabecular architectures for the young and old lumbar spines, and we observed a strong correlation between our numerical results and the actual trabecular architecture in the literature. The proposed numerical framework and results demonstrated the potential use of the topology optimization-based numerical tool for putative treatments in advance of actual clinical procedures for the patients.

In this study, we developed a numerical framework that computationally determines simultaneous and interactive structural changes of cortical and trabecular bone types during bone remodeling, and we investigated the structural correlation between the two bone types in human proximal femur. We implemented a surface remodeling technique that performs bone remodeling in the exterior layer of the cortical bone while keeping its interior area unchanged. A micro-finite element (microFE) model was constructed that represents the entire cortical bone and full trabecular architecture in human proximal femur. This study simulated and compared the bone adaptation processes of two different structures: (1) femoral bone that has normal cortical bone shape and (2) perturbed femoral bone that has an artificial bone lump in the inferomedial cortex. Using the proposed numerical method in conjunction with design space optimization, we successfully obtained numerical results that resemble actual human proximal femur. The results revealed that actual cortical bone, as well as the trabecular bone, in human proximal femur has structurally optimal shapes, and it was also shown that a bone abnormality that has little contribution to bone structural integrity tends to disappear. This study also quantitatively determined the structural contribution of each bone: when the trabecular adaptation was complete, the trabecular bone supported 54% of the total load in the human proximal femur while the cortical bone carried 46%.

Previous research has been inconclusive as to whether high peak bone mineral density (BMD, g/cm(2)) resulting from previous physical activity is retained with reduced activity later in life. The aim of this 12-year longitudinal study was to investigate the association between BMD loss and reduced physical activity (h/wk) at trabecular and cortical bone sites in men. Three groups with a mean age of 17 years at baseline were investigated: i) 51 athletes who discontinued their active careers during the follow-up period (former athletes), ii) 16 athletes who were active throughout the follow-up period (active athletes), and iii) 25 controls. BMD loss at the hip, spine, and pelvis (mainly trabecular bone) was compared to BMD loss at femur, humerus, and legs (mainly cortical bone) during a 12-year follow-up period. Across the total follow-up period in the total cohort, reduced physical activity was more strongly associated with changes at trabecular BMD sites, i.e. hip, spine, and pelvis (B=0.008-0.005 g/cm(2) per weekly hour physical activity (h), p0.001), than at cortical bone sites, i.e. humerus, legs (B=0.002-0.003 g/cm(2)/h, p0.05), and femur (p0.05). At the final follow-up, former athletes showed higher BMD than controls only at the cortical bone sites of the humerus, legs, and femur (difference 0.05-0.10 g/cm(2), p0.05). In conclusion, this study indicates that predominantly trabecular bone is lost with reduced physical activity levels in young men. Benefits were still evident at the more cortical sites eight years after the discontinuation of an active sports career.

Juvenile hyaline fibromatosis (JHF) is a rare autosomal-recessive hereditary disease, characterized by gingival hypertrophy, flexion contractures of joints, bone lesions, hyaline deposition in the extracellular spaces of the dermis and soft tissues, stunted growth, and skin lesions such as multiple nodules, tumors and pink, pearly papules. No case of JHF with a mandibular bone involvement, exists in the literature. Bone involvement in JHF is an uncommon finding and distinct solitary lesions in the calvarial bones has been reported by some authors. A 21-year-old male patient was referred to Diyarbakir Military Hospital, Department of Dental Service. Clinical findings were consistent with a solid alveolar mass in the right mandibular premolar-molar region and displaced right mandibular molar teeth. Orthopantomographic examination showed impaction of all lower right molars in a mixed radioopaque/radiolucent area. Microscopically, increased nodular connective tissue was seen under the lobulated mucosal surfaces of the resected area. The case presented here had a localized fibrous proliferation that infiltrated bone trabeculae and caused displacement of teeth. Juvenile hyaline fibromatosis should be considered in the differential diagnosis with the other intraosseous radiolucent-patchy opaque lesions of jaw bones. Based on the clinical and histopathological findings, a diagnosis of JHF was made.

Trabecular bone networks consist of two basic microstructural types: plates and rods. Although trabecular rods represent only a small fraction of total bone volume, their existence has important roles in failure initiation and progression. The goal of this study was to quantitatively examine the contributions of trabecular rods in various orientations to the anisotropic elastic moduli of human vertebral trabecular bone. Twenty-one human vertebral trabecular bone specimens were scanned by microcomputed tomography (microCT). A coordinate system of orthotropic axes representing the best elastic orthotropic symmetry was determined for each sample. Individual trabeculae segmentation (ITS), a 3D image analysis technique, was performed to identify each individual trabecular rod and determine its orientation in the orthotropic coordinate system. Next, three rod-removed images were created where longitudinal, oblique, or transverse trabecular rods were removed, respectively, from the original microCT images. The original and three categories of rod-removed images were then converted to finite element (FE) models for evaluation of their elastic moduli and anisotropy. Both the transverse and oblique rod-removal caused significant decreases in all six elastic moduli. However, the removal of longitudinal rods only caused significant changes in E(33), G(23), and G(31) but not in any transverse/in-plane elastic properties (E(11), E(22), and G(12)). The analysis of covariance (ANCOVA) with repeated measures was applied to detect the moduli change in the different models caused by the effects beyond just bone volume loss. The results suggested that the loss of transverse rods induced a significant decrease in in-plane mechanical competence, which was greater than what could be explained only by the associated bone volume loss. In contrast, the reduction in the axial Young's modulus caused by the loss of transverse rods was proportional to the bone volume decrease. Furthermore, the loss of longitudinal rods affected the axial Young's modulus through both bone volume loss and architectural change. With aging, the reduction in in-plane mechanical competence would be magnified by the preferential loss of transverse rods. The predictive ability of bone mineral density, a surrogate of BV/TV in clinical measurements, may reduce more quickly for transverse mechanical properties than for the axial mechanical properties.

One major barrier to osteosynthesis in distal humeral fractures is poor bone quality. This study was an attempt to measure the bone quality in the distal humerus.We measured the distribution of total bone mineral density (BMD), trabecular BMD (tBMD), and cortical thickness (CTh) in the distal humerus using peripheral quantitive computed tomography. Four slices in the infracondylar, supracondylar, and distal disphyseal regions of 25 human cadaver humeri were investigated.Total BMD decreased continuously from the distal diaphysis to the trochlea. Within the infracondylar region, the capitellum was the region of lowest tBMD and CTh (P.001). Measurements in anterior regions were higher than in most others (P.001). The tBMD of the medial column in the infracondylar and supracondylar regions was 31% and 36% higher vs the lateral column (P.001). The medial column had an average 22% higher CTh in the supracondylar and 38% higher CTh in distal diaphyseal regions vs the lateral sides (P.001).Distal humeral bone properties vary widely, providing stronger bone stock on the medial side. This may improve understanding of implant failure and techniques in surgical treatment.

The prediction of bone strength can be improved when determining bone mineral density (BMD) in combination with measures of trabecular microarchitecture. The goal of this study was to assess parameters of trabecular bone structure and texture of the calcaneus by clinical multi-detector row computed tomography (MDCT) in an experimental in situ setup and to correlate these parameters with microCT (microCT) and biomechanical testing. Thirty calcanei in 15 intact cadavers were scanned using three different protocols on a 64-slice MDCT scanner with an in-plane pixel size of 208 microm and 500 microm slice thickness. Bone cores were harvested from each specimen and microCT images with a voxel size of 16 microm were obtained. After image coregistration, trabecular bone structure and texture were evaluated in identical regions on the MDCT images. After data acquisition, uniaxial compression testing was performed. Significant correlations between MDCT- and microCT-derived measures of bone volume fraction (BV/TV), trabecular thickness (Tb.Th) and trabecular separation (Tb.Sp) were found (range, R(2)=0.19-0.65, p

Bone damage has been cited as an important aspect of bone quality. As such, understanding the effects of damage on the toughness of trabecular bone should provide insight into trabecular bone behavior during energy-limiting cases, such as falls. The effects of damage on the toughness of 35 bovine trabecular bone specimens were studied. Damage was induced by compressing the on-axis specimens to either 1.5% or 2.5% strain, followed by compression to 7.5% strain. The overloads resulted in significant decreases in both modulus and elastic toughness, with significantly greater decreases for the high-damage group than the low-damage group. Following damage, the elastic toughness of the high-damage group was also lower than the undamaged elastic toughness of the control group. In contrast, there was no detectable effect of damage level on toughness measured to 7.5% strain. Toughness increased linearly with BMD ( R 2 = 0.50) and by a power law relationship with volume fraction (BV/TV) ( R 2 = 0.65). Microarchitectural parameters also predicted the toughness in the absence of BV/TV or BMD. Toughness decreased with increasing slenderness ratio (Tb.Sp/Tb.Th) and structure model index (SMI) ( R 2 = 0.68, multiple regression), again independent of damage level, suggesting that failure is influenced by trabecular buckling. Taken together, the results show that normal variations in toughness due to density and architecture dominate the changes due to damage at the levels induced in this study. Moreover, measuring toughness is sensitive to the final strain, as differences found in the elastic and initial plastic regions were undetectable at higher strains. The self-limiting nature of microcracks in trabecular bone, or the trabecular architecture itself, may inhibit microcracks from propagating to macroscopic trabecular fractures, thereby limiting the effect of damage on toughness and making it difficult to detect in comparison to normal population variability.

Cranial endplates of human vertebrae are injured more often than caudal, in both young and elderly spines. We hypothesise that cranial endplates are inherently vulnerable to compressive loading because of structural asymmetries in the vertebrae.Sixty-two "motion segments" (two vertebrae and the intervening disc and ligaments) were obtained post-mortem from thirty-five human spines (17F/18M, age 48-92 yrs, all spinal levels from T8-9 to L4-5). Specimens were compressed to failure while positioned in 2-6 degrees of flexion, and the resulting damage characterised from radiographs and at dissection. 2 mm-thick slices of 94 vertebral bodies (at least one from each motion segment) were cut in the mid-sagittal plane, and in a para-sagittal plane through the pedicles. Microradiographs of the slices were subjected to image analysis to determine the thickness of each endplate at 10 locations. Optical density of the endplates and adjacent trabecular bone was also measured. Measurements obtained in cranial and caudal regions, and in mid-sagittal and pedicle slices, were compared using repeated measures ANOVA with age, level and gender included as between-subject factors. Linear regression was used to determine significant predictors of compressive strength (failure stress).Fracture affected the cranial endplate in 55/62 specimens. Cranial endplates were thinner than caudal (p=0.003) by 14% and 11% on average, in mid-sagittal and pedicle slices respectively. Caudal but not cranial endplates were thicker at lower spinal levels (p=0.01). Optical density of trabecular bone adjacent to the endplates was 6% lower cranially than caudally (p=0.004), and the average optical density of trabecular bone in mid-sagittal slices was 10% lower in women than in men (p=0.025). Vertebral yield stress (mean 2.22 MPa, SD 0.77 MPa) was best predicted by the density of trabecular bone underlying the cranial endplate of the mid-sagittal slice of the fractured vertebra (r(2)=0.67, p=0.0006).When vertebrae are compressed naturally by adjacent intervertebral discs, cranial endplates usually fail before caudal endplates because they are thinner and supported by less dense trabecular bone.

Udgivelsesdato: 2009-Nov An episode of ischemia followed by reperfusion of the femoral head (FH) is thought to be a common pathway in the pathogenesis of femoral head necrosis (FHN). Femoral head histology was investigated after short-term high-dose steroid treatment and femoral head ischemia and reperfusion in a large animal model. Twenty-two pigs were randomized to receive methylprednisolone 20mg/day/kg bodyweight intamuscularly for 3 days followed by methylprednisolone 10mg/day/kg bodyweight for 11 days (n=11), whereas the control group (n=11) received no treatment. After 6h of unilateral hip-joint pressure increase to 250mmHg, the pressure was discontinued and reperfusion was allowed for 4h. Undecalcified histology was performed for the femoral head subchondral region, the mid-region, and the region adjacent to the growth plate. Congestion phenomena were predominantly discerned in femoral head sections of the tamponaded hips. Histomorphometry revealed fat cell hyperthrophy and reduced hemopoetic marrow cells in the femoral heads of the steroid-treated group of animals. The number of blood vessels and bone trabeculae remained unchanged. These characteristics may correlate with early-stage femoral head necrosis.

Trabecular bone density changes throughout the proximal tibia are indicative of several musculoskeletal disorders of the knee joint. Many of these disorders involve not only changes in the amount of bone, but also in the surrounding soft tissue. Osteoarthritis, for instance, involves bone density changes below the subchondral bone and throughout the proximal tibia, along with degradation evident in the articular cartilage. Osteoporosis, characterized by low bone density may also involve changes in bone size, structure or microarchitecture, each of which may contribute to fracture risk. Recent studies have shown that magnetic resonance (MR) imaging, most frequently applied for soft tissue imaging, also allows non-invasive 3-dimensional characterization of bone microstructure. The purpose of the current study is to use whole joint MR images to acquire regional apparent bone volume fraction (appBVF) throughout the proximal tibia and correlate with mechanical properties measured on the corresponding ex vivo specimens. To compare our method to a high-resolution imaging modality, micro-CT analysis was performed in a subset of specimens. Using linear mixed-effects models, significant correlations (p0.05) were determined between MR appBVF and Young's modulus (r(2)=0.58, MPSE=3633 MPa(2)), yield stress (r(2)=0.73, MPSE=1.53 MPa(2)) and ultimate stress (r(2)=0.72, MPSE=2.29 MPa(2)). Comparable significant correlations (p0.05) were also determined between micro-CT BVF and Young's modulus (r(2)=0.47, MPSE=5179 MPa(2)), yield stress (r(2)=0.80, MPSE=1.23 MPa(2)) and ultimate stress (r(2)=0.83, MPSE=1.76 MPa(2)). The current study demonstrates that MR imaging may be used as an in vivo imaging tool to determine differences in bone strength between subjects and regional variations within a single tibia.

A three dimensional (3D) computational simulation of dynamic process of trabecular bone remodeling was developed with all the parameters derived from physiological and clinical data. Contributions of the microstructural bone formation deficits: trabecular plate perforations, trabecular rod breakages, and isolated bone fragments, to the rapid bone loss and disruption of trabecular microarchitecture during menopause were studied. Eighteen human trabecular bone samples from femoral neck (FN) and spine were scanned using a micro computed tomography (microCT) system. Bone resorption and formation were simulated as a computational cycle corresponding to 40-day resorption/160-day formation. Resorption cavities were randomly created over the bone surface according to the activation frequency, which was strictly based on clinical data. Every resorption cavity was refilled during formation unless it caused trabecular plate perforation, trabecular rod breakage or isolated fragments. A 20-year-period starting 5 years before and ending 15 years after menopause was simulated for each specimen. Elastic moduli, standard and individual trabeculae segmentation (ITS)-based morphological parameters were evaluated for each simulated 3D image. For both spine and FN groups, the time courses of predicted bone loss pattern by microstructural bone formation deficits were fairly consistent with the clinical measurements. The percentage of bone loss due to trabecular plate perforation, trabecular rod breakage, and isolated bone fragments were 73.2%, 18.9% and 7.9% at the simulated 15 years after menopause. The ITS-based plate fraction (pBV/BV), mean plate surface area (pTb.S), plate number density (pTb.N), and mean rod thickness (rTb.Th) decreased while rod fraction (rBV/BV) and rod number density (rTb.N) increased after the simulated menopause. The dynamic bone remodeling simulation based on microstructural bone formation deficits predicted the time course of menopausal bone loss pattern of spine and FN. Microstructural plate perforation could be the primary cause of menopausal trabecular bone loss. The combined effect of trabeculae perforation, breakage, and isolated fragments resulted in fewer and smaller trabecular plates and more but thinner trabecular rods.

The separate and combined effects of intermittent parathyroid hormone (iPTH) (1-34) and mechanical loading were assessed at trabecular and cortical sites of mouse long bones. Female C57BL/6 mice from 13 to 19 weeks of age were given daily injections of vehicle or PTH (1-34) at low (20 microg/kg/day), medium (40 microg/kg/day) or high (80 microg/kg/day) dose. For three alternate days per week during the last two weeks of this treatment, the tibiae and ulnae on one side were subjected to a single period of non-invasive, dynamic axial loading (40 cycles at 10 Hz with 10-second intervals between each cycle). Two levels of peak load were used; one sufficient to engender an osteogenic response, and the other insufficient to do so. The whole tibiae and ulnae were analyzed post-mortem by micro-computed tomography with a resolution of 5 microm. Treatment with iPTH (1-34) modified bone structure in a dose- and time-dependent manner, which was particularly evident in the trabecular region of the proximal tibia. In the tibia, loading at a level sufficient by itself to stimulate osteogenesis produced an osteogenic response in the low-dose iPTH (1-34)-treated trabecular bone and in the proximal and middle cortical bone treated with all doses of iPTH (1-34). In the ulna, loading at a level that did not by itself stimulate osteogenesis was osteogenic at the distal site when combined with high-dose iPTH (1-34). At both levels of loading, there were synergistic effects in cortical bone volume of the proximal tibia and distal ulna between loading and high-dose iPTH (1-34). Images of fluorescently labelled bones confirmed that such synergism resulted from increases in both endosteal and periosteal bone formation. No woven bone was induced by iPTH (1-34) or either level of loading alone, whereas the combination of iPTH (1-34) and the "sufficient" level of loading stimulated woven bone formation on endosteal and periosteal surfaces of the proximal cortex in the tibiae. Together, these data suggest that in female C57BL/6 mice, under some but not all circumstances, mechanical loading exerts an osteogenic response with iPTH (1-34) in trabecular and cortical bone.

Objective To evaluate the effect of autologous bone marrow mesenchymal stem cells (BMSCs) seeded bio-derived bone materials (BBM) combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) in repairing defect of osteonecrosis of femoral head (ONFH). Methods Early-stage osteonecrosis in the left hip was induced in 36 adult New Zealand white rabbits (provided by the Animal Center of Guangxi Medical University, Nanning, China) after core decompression and delivery of liquid nitrogen into the femoral head. Then the animals were divided into three groups according to the type of implants for bone repair: 12 rabbits with nothing (Group I, the blank control group), 12 with BBM combined with rhBMP-2 (Group II), and 12 with BMSCs-seeded BBM combined with rhBMP-2 (Group III). At 4, 8, and 12 weeks after surgery, X-ray of the femoral head of every 4 rabbits in each group was taken, and then they were killed and the femoral heads were collected at each time point, respectively. Gross observation was made on the femoral heads. After hematoxylin and eosin staining, Lane-sandhu scores of X-ray and bone densitometry were calculated and the histomorphometric measurements were made for the new bone trabeculae. Results At 12 weeks after surgery, two femoral heads collapsed in Group I, but none in Group II or Group III. X-ray examination showed that the femoral heads in Group I had defect shadow or collapsed while those in Group II had a low density and those in Group III presented with a normal density. Histologically, the defects of femoral heads were primarily filled with no new bone but fibrous tissues in Group I. In contrast, new bone regeneration and fibrous tissues occurred in Group II and only new bone regeneration occurrd in Group III. Lane-sandhu scores of X-ray, bone mineral density and rate of new bone in trabecular area in Group III were higher significantly than those of the other two groups. Conclusions Our findings indicate a superior choice of repairing the experimental defect of ONFH with BMSCs-seeded BBM combined with rhBMP-2.

X-ray imaging remains a very cost-effective technique, with many applications in both medical and material science. However, the physical process of X-ray imaging transforms (e.g. projects) the 3-dimensional (3D) microarchitecture of the object or tissue being studied into a complex 2D grey-level texture. The 3D/2D projection process continues to be a difficult mathematical problem, and neither demonstrations nor well-established correlations have positioned 2D texture analysis-based measurement as a valid indirect evaluation of 3D microarchitecture. The trabecular bone score (TBS) is a new grey-level texture measurement which utilizes experimental variograms of 2D projection images. The aim of the present study was to determine the level of correlation between the 3D characteristics of trabecular bone microarchitecture, as evaluated using muCT reconstruction, and TBS, as evaluated using 2D projection images derived directly from 3D muCT reconstruction. Analyses were performed using sets of human cadaver bone samples from different anatomical sites (lumbar spine, femoral neck, and distal radius). Significant correlations were established via standard multiple regression analysis, and via the use of a generic mathematical 3D/2D relationship. In both instances, the correlations established a significant relationship between TBS and two 3D characteristics of bone microarchitecture: bone volume fraction and mean bone thickness. In particular, it appears that TBS permits to accurately differentiate between two 3D microarchitectures that exhibit the same amount of bone, but different trabecular characteristics. These results demonstrate the existence of a robust and generic relationship, taking into consideration a simplified model of a 2D projection image. Ultimately, this may lead to using TBS measurements directly on DXA images obtained in routine clinical practice.

Vertebral fractures may result in pain, loss of height, spinal instability, kyphotic deformity and ultimately increased morbidity. Fracture risk can be estimated by vertebral bone mineral density (BMD). However, vertebral fractures may be better defined by more selective methods that account for micro-architecture. Our aim was to quantify regional variations in bone architecture parameters (BAPs) and to assess the degree with which regional variations in BAPs affect vertebral fracture strength. The influence of disc health and endplate thickness on fracture strength was also determined. The soft tissue and posterior elements of 20 human functional spine units (FSU) were removed (T9 to L5, mean 74.45+/-4.25 years). After micro-CT scanning of the entire FSU, the strength of the specimens was determined using a materials testing system. Specimens were loaded in compression to failure. BAPs were assessed for 10 regions of the vertebral cancellous bone. Disc health (glycosaminoglycan content of the nucleus pulposus) was determined using the degree of binding with Alcian Blue. Vertebrae were not morphologically homogeneous. Posterior regions of the vertebrae had greater bone volume, more connections, reduced trabecular separation and more plate-like isotropic structures than their corresponding anterior regions. Significant heterogeneity also exists between posterior superior and inferior regions (BV/TV: posterior superior 12.6+/-2.8%, inferior 14.6+/-3%; anterior superior 10.5+/-2.2%, inferior 10.7+/-2.4%). Of the two endplates that abutted a common disc, the cranial inferior endplate was thicker (0.44+/-0.15 mm) than the caudal superior endplate (0.37+/-0.13 mm). Our study found good correlations between BV/TV, connective density and yield strength. Fracture risk prediction, using BV/TV multiplied by the cross sectional area of the endplate, can be improved through regional analysis of the underlying cancellous bone of the endplate of interest (R(2) 0.78) rather than analysis of the entire vertebra (R(2) 0.65) or BMD (R(2) 0.47). Degenerated discs lack a defined nucleus. A negative linear relationship between disc health and vertebral strength (R(2) 0.70) was observed, likely due to a shift in loading from the weaker anterior vertebral region to the stronger posterior region and cortical shell. Our results show the importance of considering regional variations in cancellous BAPs and disc health when assessing fracture risk.